The Maritime SPOR SUPPORT Unit (MSSU) has released a rapid literature review about palliative and end-of-life care during pandemics. The report summarizes recommendations and practices drawn from experiences providing end-of-life care during COVID-19 and other infectious disease outbreaks.
The review was initiated by the MSSU team in Moncton to support the Vitalité Health Network, a regional health authority that provides health care services to francophone communities in northern and southeastern New Brunswick.
“End-of-life care presents clinicians, patients and families with difficult circumstances – and these can be all the more challenging during a pandemic, with infection control measures and changes to staff and resources. We needed to move quickly to learn from past experience and other jurisdictions,” said Brigitte Sonier-Ferguson, Regional Director, Research, Scientific Development and Training at Vitalité Health Network.
With just two days to prepare, the team in Moncton scanned scientific articles, news articles and government publications to collect information about providing palliative and end-of-life care during COVID-19, as well as recommendations arising from other infectious disease outbreaks including SARS (Severe Acute Respiratory Syndrome) and MERS (Middle East Respiratory Syndrome).
“We had to find a different way of working. It was really very intensive. Despite the time constraints, we reviewed many articles, and were able to pinpoint some common concerns and strategies. These are easily accessible in the report,” said Dr. Marc Robichaud, Research Professional with the MSSU, and one of the co-authors of the report.
One emerging theme was the use of digital technology to help patients and their loved ones stay connected, particularly when visitor restrictions are necessary.
“The public health measures needed to control the spread of COVID-19 mean patients are often not able to visit with their loved ones—it can be heartbreaking for the families. Especially, when these separations happen in the patient’s final days or hours. We’ve seen a lot of creativity amongst hospital staff and health care workers in terms of how to bridge the distance between patients and their loved ones, whether it was through the use of tablets, such as iPads, laptops or smartphones, or by organizing videoconferences. These are a few examples of the changes that were carried out to help bring patients and their families closer together,” said Robichaud.
Another common theme was advanced planning, a process whereby patients document their decisions about the treatment they wish to receive, share values and beliefs that guide their decision making, and identify someone to make decisions on their behalf, if they are no longer able to make those decisions themselves.
“Having discussions around advance care planning early on, and making sure that the patient’s family is aware of their wishes can help ease the stress sometimes placed health care providers or on loved ones, should they eventually have to make these decisions on behalf of patients,” added Robichaud.
The report summarizes practices outlined in the literature in an easy to scan table that includes links to sources for more information.